Provider Demographics
NPI:1275736613
Name:KELSEY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:KELSEY CHIROPRACTIC, PLLC
Other - Org Name:HEALTHSOURCE OF OAKDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-538-4558
Mailing Address - Street 1:5705 HADLEY AVE N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-1022
Mailing Address - Country:US
Mailing Address - Phone:651-538-5448
Mailing Address - Fax:651-409-3019
Practice Address - Street 1:5705 HADLEY AVE N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-1022
Practice Address - Country:US
Practice Address - Phone:651-538-5448
Practice Address - Fax:651-409-3019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU93369Medicare UPIN
MN350002765Medicare ID - Type Unspecified